Health Plan Clinical Analyst, Data Scientist

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $120k - $135k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

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Health Network One

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification.

📋 Description

• Lead the design, development, and optimization of enterprise clinical performance dashboards (e.g., utilization, care management effectiveness, access metrics, and quality performance). • Development of recurring and adhoc analytics using SQL, Excel, and Power BI. • Translate complex clinical datasets into strategic recommendations for executive leadership, operational teams, and quality stakeholders. • Establish data validation standards and ensure accuracy, completeness, and integrity across reporting environments. • Serve as a senior subject-matter expert for clinical analytics methodologies, performance measurement, and reporting best practices. • Partner with clinical and operational leadership to define KPIs aligned with enterprise performance goals.

🎯 Requirements

• Bachelor’s degree (or equivalent experience) in public health, data analytics, health informatics, business, or a related field. • 5+ years of experience with advanced proficiency in SQL, Excel, and Power BI • 3+ years of experience working with healthcare plan datasets, including claims, utilization management/prior authorization, care management, and quality measures. • Strong understanding of clinical workflows, utilization and network management analytics, and healthcare economics. • Demonstrated ability to translate complex analytics into executive-level insights and operational recommendations. • Excellent stakeholder engagement, communication, and strategic problem-solving skills. • Self-starter with the ability to manage multiple priorities independently.